Obesity is now recognized as a serious chronic disease, but there is pessimism about how successful its treatment can be. A general perception is that almost no one succeeds in long-term maintenance of weight loss.

Successful long-term weight loss maintenance is defined as intentionally losing at least 10% of initial body weight and keeping it off for at least 1 year. According to this definition, more than 20% of overweight/obese persons will be able to achieve success.

Loss of excess weight can improve blood lipids, insulin sensitivity, and blood pressure. Since nearly 70% of US adults are classified as overweight or obese, losing weight has become a top priority. Whereas shedding unwanted pounds may be exceedingly difficult, keeping weight off after dieting ends is even more challenging.

Many lifestyle factors (e.g., peer support, willpower, and meal frequency) have been explored related to whether a person is able to maintain the lost weight.

The tested strategies

The National Weight Control Registry found that successful long-term weight loss maintainers (average of 30 kg for an average of 5.5 years) share common behavioral strategies, including eating a diet low in fat, frequent self-monitoring of body weight and food intake, and high levels of regular physical activity. Weight loss maintenance may get easier over time. Once these successful maintainers have maintained a weight loss for 2-5 years, the chances of longer-term success greatly increase.

Generally those who are successful in losing and maintaining large amounts of weight also report lower depression and stress. Increased susceptibility to cues that trigger overeating may increase risk of weight regain.

An exercise program combined with diet modification may be the key to losing weight and keeping it off. Many patients who are already at healthy weights find that physical activity helps to prevent weight gain. Accumulating frequent short bouts of moderately intense activity can be as effective as performing longer exercise sessions less often. Aerobic exercise alone may not be enough to preserve lean muscle mass when weight is lost, but incorporating resistance exercise may prevent reductions in resting metabolic rate and lean body mass.

More men than women are classified as successful pound loss maintainers. Adults who reported not eating at fast-food restaurants were more successful at weight loss maintenance, adults who consumed fewer than five fruit and vegetable servings per day and accrued 420 minutes or more per week of physical activity or consumed five or more fruit and vegetable servings and accrued 150 minutes or more per week of activity were more successful.

If you have tried any of these and failed keeping weight off, don't feel guilty for it might not be your fault. It seems that genetic factors might contribute to the ease with which weight loss is maintained. It has been recently reported that differences in adipose tissue gene expression after dieting might be important predictors of whether a person is able to maintain his or her weight loss.

Why some people will succeed in keeping weight off while others won't?

Two main factors seem to play a role in keeping shed pounds off, blood insulin and the expression of several genes related to lipid metabolism in adipose tissue.

It has been observed that people who successfully maintained weight loss after a low-calorie diet had lower blood insulin concentrations at the completion of the weight-loss phase. No such decrease has been noted in people who experienced weight regains.

In addition, adipose tissue expression of several genes related to lipid metabolism, ATP production, and cell death was regulated differently after weight-loss.

Importantly, changes in blood insulin and adipose tissue genes seem not to be related to the different nutrient composition of the weight-maintenance diet meal plan.

Different treatment approaches

Behavioral self-management training is the state of the art in the treatment of obesity. However, most of those treated experience only temporary success in keeping weight off. In some individuals, relapse appears to be related to the development of binge eating, which is characterized by perceived lack of eating control and symptoms of food dependence. Treatment for such patients should be based on the assumptions that self-management is very difficult and that emphasis should be on cognitive-behavioral methods with a reliance on social support for control of behavior. For some patients, continued use of the self-management model may result in harmful weight cycling.

The behavioral strategy of reducing consumption of fast foods could assist people in keeping weight off. The combined approach of consuming five or more fruit and vegetable servings per day and attaining 150 minutes or more per week of physical activity was a common strategy among adults successful at weight loss maintenance.

Other factors like blood insulin and gene expression in adipose tissue seem to determine successful weight loss maintenance. The good news here is that these findings may eventually allow your doctor to predict if you will need additional assistance after successful weight loss.

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